The law of unintended consequences continues to dog the much-maligned Part D program. So far, seniors and states have been depicted as the primary victims of the program’s operational, structural, and marketing faults. Now there’s news that the program’s impact on pharmacists is resulting in political fallout for the White House.
The New York Times reported yesterday that a (free registration required) group of pharmacists from Texas met with White House political boss Karl Rove to voice concerns about Part D. While their complaints include the additional time required of pharmacists to explain the program to seniors and advise them on which of the myriad offerings works best for them, by far the more significant issue appears to be the financial fallout.
Pharmacies’ problems include slow payment by Part D vendors; lower reimbursement rates; extra labor costs incurred while (free registration required) pharmacists wrestled with administrative nightmares; and the cost of free scripts given away to seniors lost in the bureaucratic mess.
According to a pharmacist in California: “It’s really bad and it’s been a disaster for us…Our reimbursement rates have gone down. Medicare Part D has really hurt us.”
While the administrative and operational issues look to be solvable, the reimbursement issue will not go away. Pharmacists are discovering that in many cases their reimbursement under Part D is less than it was under Medicare, making Part D significantly less attractive. And that comes on top of a reduction in Medicaid drug dispensing fees that went into effect last year.
According to the pharmacists from Bush’s home state, these problems have combined to push many pharmacies, especially the mom-and-pops, to the financial brink. The result is these independent business people, many of which have been ardent supporters of the President, feel victimized by the program. Bush’s recent comment that “It’s not immoral to make sure that prescription drug pharmacists don’t overcharge the system” further alienated pharmacists.
The winners in Part D look to be big pharma, PBMs, managed care firms, and employers. In addition to taxpayers, seniors and pharmacies, losers may include the President and his allies on Part D.

Reports out of Washington indicate Pres. Bush’s plans to expand HSAs by increasing the amount individuals can set aside tax-free are not gaining much traction on Capitol Hill. Sen. Chuck Grassley (R Nebraska) and other Republicans are not in favor of the move.
This is not Bush’s only problem related to health care. Some 60 House Republicans have refused to back the Bush Medicare budget cuts, breaking wiith the President despite calls for fiscal prudence. One wonders if election year politics has anything to do with this. Actually, there’s no wondering.
Republicans, faced with a President with historically low approval ratings (well, pretty close to historical lows) look to be scrambling for cover – and with seniors particularly upset with the GOP over the Part D mess, a cut to Medicare would increase their problems.
The situation on the Hill makes CMS Director McClellan’s recent pronouncements about adding HSAs to Medicare (Part G?!) somewhat…puzzling? Faced with concerns about both HSAs and Medicare among their own party leaders, why is McClellan floating this trial balloon? One can only imagine the reaction among seniors who have been tearing their hair out over Part D. If we thought Part D was complicated and hard to explain, I can’t wait to see our nation’s political leaders on a bus traveling around talking to seniors about HSAs.
What are these people thinking? Or rather, are these people thinking?
What does this mean for you?
Politics in an election year can be good and bad – killing the ill-conceived HSA expansion while not addressing some of the real concerns with Medicare are two great examples.